Provider Demographics
NPI:1598290769
Name:MAXWELL B. MERKOW MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MAXWELL B. MERKOW MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:B
Authorized Official - Last Name:MERKOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-309-5155
Mailing Address - Street 1:29 ORINDA WAY UNIT 429
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-6918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 LA CASA VIA BLDG 2#110
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3082
Practice Address - Country:US
Practice Address - Phone:925-309-5155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAA141272207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA141272OtherLICENSE NUMBER